Uneveness and Thin Tear Trough Area Skin 10 Months After Blepharoplasty with Fat Grafting, What Should I do Now? (photo)

After a Blephoplasty and fat grafting 10 months ago, i have been left with uneveness on the lower lid/cheek junction on the RHS. I also have thin skin on the lower eyelids which is always dark especially in the corner going down to the tear trough area. Partly from skin thinness and partly pigmentation. I look old and tired from the darkness and a little strange from the uneveness on the cheek area. The doctor did a second fat graft 4 months ago and the uneveness has now increased. Please help.

Doctor Answers 10

Fat Grafting To Lower Eyelids Has Failed To Correct Suborbital Depression Of Mid Face

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Your lower eyelid tissue is no longer covering the orbital rim.  This will certainly be improved and/or corrected by a cheek implant, a mid facelift, or Radiesse.  The fat that was grafted in, is an island of elevation in a sea of depression. 

Since your physician has twice attempted fat grafting to correct this problem, I would seek a second opinion from a Board Certified plastic surgeon, member of ASPS and ASAPS, and having significant experience in lower lid reconstruction. 

Uneveness and Thin Tear Trough Area Skin 10 Months After Blepharoplasty with Fat Grafting, What Should I do Now?

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I think at this time, using hyaluronic acid filler like Restylane to fill the area in is a good idea. That should lift the skin up so the light reflects better on it making it look less dark and will hide some of the depressions.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Many different techniques

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You have no doubt hear the phrase: "there are many ways to skin a cat". Although I'm unsure of the origin of this phrase, it no doubt applies to this situation.

Hyaluronic acid fillers [restylane/juviderm], fat grafting [injection], and fat repositioning [blepharoplasty with adjustment of the eyelid fat] have all been used to address your problem with varying degrees of success, depending on surgeon technique and patient anatomy and healing.

Fat grafting was a viable first option, but considering that it seems not to have been effective, it is reasonable to use one of the other options. You seem to still have fat prolapse in the lower eyelid, and repositioning this into the hollowness just below it would be a possibility [if the fat pockets were NOT manipulated during the first surgery. If they were, there will likely be scarring present which will make this option less predictable/effective]

The "off the shelf" fillers, as advocated by many here, is also an excellent option. It is reversible, but not permanent, though in some in can last for over a year.

Choose an surgeon with experience/expertise in eyelid surgery and injections

Best of luck.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Unevenness of Lower Lid after Fat Transfer and Blepharoplasty

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You appear to have a failed fat graft with age related deflation of the areas around the eyes. The darkness is related to the thinness of the skin allowing the reflection of the underlying muscle to be seen. Your appearance my be improved with either micro fat grafting or placement of Restylane. 

Peter A. Aldea, MD
Memphis Plastic Surgeon

Uneveness and Thin Tear Trough Area Skin 10 Months After Blepharoplasty with Fat Grafting, What Should I do Now? (photo)

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The one photos helps a bit but in person examination is always better. I recommend trying small dose short acting Restylane on only the right lower lid to see if there is any improvement.

My lower eyelids are hollow and look tired.

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Fat grafting is less predictable than fat repositioning, and even less predictable than off the shelf fillers such as hyaluronic acid or calcium hydroxyapatite.  If the appearance bothers you, have it revised, preferable NOT with another session of fat grafting.  

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Grafted fat is less than ideal for such a thin eyelid.

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Given how thin your lower eyelids are, at least from the photos, I think the result could be acceptable for some.  Generally with skin this thin, the best option is filling the lower eyelid with a product like  Restylane.  Restylane can be adjusted after the fact, if needed, with a simple injection of hyaluronidase.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Fat grafting after blepharoplasty

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Fat grafting should be effective to fill the tear trough and reduce the line and hollow in the lower lid. If the grafts are placed well, it should be possible to even out your lower lids without surgery.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Fat grafting tear trough and irregularities.

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I have been doing fat grafting for 35 years and I only do it with a blepharoplasty-not by injection. The reason is that fat will make a sausage in the lower lid such as you have. You have 2 choices---1- revision blepharoplasty or 2-slowly adding fillers around the bump. See an experienced surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Lower eyelid asymmetry after blepharoplasty and fat graft

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It's a little tough to see in the photo but I do detect the asymmetry.  Was there a fat bag removed that you're aware of?  Was the fat grafted into the tear trough or anterior to the orbital bone rim?  Some surgeons have some difficulty with finding the true tear trough without having the area actually open during surgery.  I'm sorry I couldn't be of more help.  I really need a physical on this one.  If this was done via an external incision it also looks like a little more muscle was trimmed on the left vs. the right.

The best thing you can do is see a good reconstructive facial plastic or oculoplastic surgeon.

Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.